from symptom to therapy

yogabook / from symptom to therapy

General information

This complete work is written for all people with a clear professional interest who usually – but not necessarily – deal with yoga professionally or want to take a look at the asanas of yoga from their domain.
As a rule, the classical yoga teacher is not also a doctor, physiotherapist, osteopath or alternative practitioner. In most countries, this means that they are prohibited from making a diagnosis as well as prescribing and carrying out a therapeutic measure. And yet this has a certain vagueness. Linguistically, for people without a healing licence, the boundary between what is permitted and what is not lies somewhere between formulations such as „It would be good to know whether this is a disc disease so that we know what to avoid.“ and „This is a disc disorder.“ In the first case, it would be difficult to see this as a suspected diagnosis, let alone a diagnosis, but the latter is clearly a diagnosis, regardless of whether the person making it was competent to make it in the first place. Wherever the exact boundary lies, it should always be possible and permissible for the yoga teacher to point out to the person being taught the weaknesses or overtension of certain muscle groups, the peculiarities of their posture and their possible long-term consequences. In the same way, he can, may and should point out to his student everything that might require medical clarification according to his knowledge. If he wanted to fulfil this requirement more comprehensively, he would have to have a training that goes far beyond the normal, more extensive yoga teacher training courses of between 500 and 800 hours that are currently on the market, not to mention such absurd promises of becoming a „yoga teacher“ in 2 or 4 weeks. However, as this entire work is written for all teachers, regardless of their legal status and the jurisdiction in which they live, a little should be said here about diagnosing. The test has its own page.

Diseases of the musculoskeletal system

Diseases of the movement system are very diverse. Some are due to genetic disposition, others are traumatic in nature, while others are primarily caused by overuse, i.e. by using the musculoskeletal system beyond its resilience or without observing the necessary regeneration times. Then there are those that are caused or favoured by muscular imbalances. Some occur early in life, others in adolescence, some mainly in people who are active in certain ways, and the occurrence of others correlates with age. Some disorders can be cured so that the movement system functions as intended, others remain, some of which tend to worsen, often depending on how the person uses their movement system. The practitioner must therefore have a great deal of knowledge and compare a lot of information if they want to derive the correct diagnosis from a reported or observed symptom or syndrome and subsequently recommend a suitable therapy or present a selection of therapy options, the advantages and disadvantages of which are presented to the patient.

Some disorders also tend to cause further disorders, which can happen quickly or slowly. It is not uncommon for secondary disorders to occur at different distances from the primary ones, simply due to their common position in the statics or due to the connecting kinetic chain. It is not always easy to find out which disorder is primary and which is secondary, and how best to treat it sustainably. An osteopath often has the best knowledge of such complex disorders.

This work presents a variety of different diseases of the movement system, in which the most common ones should be found, but also some that even experts may have rarely seen in many years of practice. Wherever possible and sensible, tips are given on helpful asanas and those to avoid, but also beyond the asanas in the direction of strengthening training or sport.

Finding out

Anamnesis

The specific questioning of the patient about the symptom described at the beginning, for which he or she consults the practitioner, and everything possibly associated with it, is referred to as anamnesis and always forms the basis of the following physical examination and, if necessary, further examination methods. In the case of an examination arising from a teaching situation, the situation is only slightly different in that the pupil is already a patient of the teacher and does not seek him out specifically because of the symptoms. It is also possible that the teacher is the one who has discovered the symptom or brings it up. As a rule, of course, it is not possible to deal with a complete diagnosis of an individual in a teaching situation such as a public class. The situation would be different if this arose from an individual, i.e. a 1:1 teaching situation.

In principle, taking a medical history is an advanced craft, but one that has obviously been neglected in the past, a neglect that must be blamed on both the practitioners and those who trained them. Today, for example, there are increasing reports of patients whose orthopaedic surgeon did not consider it necessary to leave his chair for a physical examination, or who willingly offered to prescribe a medication based on the first description of symptoms without any further anamnestic questions or physical examination in order to be able to process the patient in under 3 minutes for economic reasons. Even if patients sometimes justifiably wonder about the brevity or omission of the medical history, they can least of all be blamed for the observed decline of the medical history in daily practice, as they visit a medical practitioner in the justified expectation of being treated conscientiously according to the state of medical science. It is essential to rediscover the medical history for what it is: the most important pillar of the diagnostic process alongside and before the physical examination.

In this context, the medical history is a special case of the general medical history and includes at least the following areas

current symptoms
Past medical history
Dispositions such as allergies, for example
Familial and known genetic predispositions
Relevant data on life situation such as occupation, hobby, sports anamnesis
psychological stress
Age and gender
Social history, if applicable

Questions are asked about the current symptom:

How long has the symptom existed?
How did it develop?
Is there a history related to movement and posture or any activities?
Is there a triggering trauma?
Have there been the same or similar symptoms before (first occurrence or recurrence)?
Where exactly is the symptom? In the case of pain, the one-finger method is helpful here: point slowly and as precisely as possible with one finger to the point in the body where the pain is located or where it is at its maximum. If the pain is not localised, then point to the area where the pain is localised. Is it a more or less round area or what shape is it? Is it elongated and from where to where does it stretch? Is the elongated extension wide or narrow?
Is the pain deep or superficial?
Is the localisation constant or does it vary?
What is the sensory pain quality: rather burning, pressing, pulling, stabbing, sharp, dark, bright, throbbing, knocking, lashing, hot, cold, pulsating?
What is the affective pain quality: rather moderate or paralysing, agonising, gruelling, torturous, devastating?
What is the intensity of the pain: rate on a scale from 0 (no sensation at all) to 10 (maximum imaginable pain).
Are there modalities such as improvement or worsening by something specific such as a movement, a posture, a position, a time of day, by rest or movement, by sleep, by heat, by cold, by food intake, by draughts and the like?
Does the pain change due to activity at all or due to activity related to the painful body area (and if so, due to which activity)?
Has a change due to other factors been observed?

In many cases, the information gathered by answering these questions may already be sufficient for a suspected diagnosis.

Physical examination

The physical examination is an essential part of the examination of the musculoskeletal system. This includes in particular the physical examination with the core components:

Inspection

One of the methods of physical examination: visual evaluation or visual assessment. The inspection is a very broad field in which the teacher can gain a lot of information about their pupil. This begins with all aspects of external appearance, which he must of course collect without personal judgement or expression of his affinities and preferences, as far as he is able. Entering the classroom for the first time for a trial lesson, and possibly even the telephone call to arrange it, creates a first impression which, as we know today, clearly influences the subsequent relationship, even if the teacher is usually less aware of this and must be and remain open at all times to what is happening and any deviations from the first impression. The first postures performed, how the student performs them, how he adopts them, what mistakes he makes, what difficulties and limitations he has, what unexpected effects occur, what questions he has about them and what he answers when questioned about them – all this is very important information for the teacher, which is not purely inspectorial, but also partly verbal and dialogical and does not allow a prediction of the student’s development, but can reveal important determinants that reflect the student’s state of being and significantly shape the content and mode of the joint work. The tendency towards precision or lack thereof, the degree of flexibility and strength or lack thereof, even in certain areas, the visible tonus of the musculature, its quantity, form and distribution, the expressed body awareness and coordination, the basic posture that the trainee habitually adopts without further instruction, the tendency to approach limits and the effects that occur, such as changes in facial features, breathing, any trembling or shyness towards limits, are all important statements.

There are numerous concrete examples of facts perceived through inspection, such as observing the straightness of the spine in postures, the parallelism of the tendons of the middle fingers or the centre lines of the feet, the height of hip bones or shoulders in side-to-side comparison (is one of them higher?), the assessment of an angle, such as the centre lines of the feet, but also the silhouette, such as the gluteus maximus in the dog’s head up position, the width and height of which allows conclusions to be drawn, whether the gluteus maximus contributes to extension or to the reduction of flexion in the hip joint. The inspection of the trapezius line also provides information on this, whether the shoulder blades are in the 2. Warrior position elevated, depressed or in a position in between. In many cases, inspection of the spine provides important information about the presence of scoliosis, that of the pelvis in symmetrical standing postures on the presence of pelvic obliquity. In supta virasana there is often a SIAS is raised in relation to the other or one leg visibly deviates into abduction, while the other is in the adduction. Then the inspection is the basis for further investigation, such as from which force the evasion occurs. Many assessments based on inspection can only be made relatively, i.e. by side-by-side comparison or comparison with a final position.

Percussion

One of the methods of physical examination: tapping on a part or area of the body. Percussion is only of secondary importance in asana. In terms of the acoustic evaluation of percussion, as used in medical examinations of the lungs, for example, there are hardly any examples. in various tests, such as the Tinel type for carpal tunnel syndrome (see the test), the cubital tunnel syndrome (see the test) or the tarsal tunnel syndrome (see the test) the affected nerves are percutaneous several times, to reproduce known symptoms in the sense of a provocation test.

Palpation

One of the methods of physical examination: palpation using the examiner’s sense of touch. Palpation is again much more important than percussion. This allows muscle tensions to be perceived, namely the desired increased or high tonus during muscular activity as well as the undesirably increased tonus. Irregularities in tissue that can be palpated superficially can also be palpated, for example a ganglion, a swelling or myogelosis can be palpated, as well as continuity fractures in muscles (muscle fibre tear), tendons (tendon tears) or bones (bone fracture).
The palpation is also important in pain provocation tests when it comes to pressure pain in tissues, be it muscle insertions, bursae or joint fissures. The pressure soreness of tense muscles, which is unpleasant for people at rest or in motion, is another classic application of palpation.

For example, the tension of the armbiceps can be palpated in the free rotation seat to determine whether this is working and roughly how intensively, whether this and roughly how intensively it works in order to be recognised as the frontal abductor of the shoulder joint to push the ipsilateral shoulder area backwards and thus promote rotation of the spine and, as elbow flexor because of the hand as punctum fixum to pull down the shoulder area and thus the shoulder blade to depress and help to equalise the height of both shoulders in the posture. If the examiner wants to palpate the tension of a muscle in order to deduce how intensively a muscle is working, they must relate the tension felt, i.e. the resistance to the palpator’s pressure, to the resting tone palpated. Only from the delta can an approximate assessment of the work of the muscle be made. However, it is not possible to draw conclusions about the exact tendon force of the muscle. Other examples of the use of palpation include the palpation of the tendon course of the biceps in the corresponding exploration, of the tissue tone of the gastrocnemius in supta virasana / virasana to understand, whether a reported pain is due to tissue compression. The palpation is also used, for example, to determine the tone of the quadriceps in uttanasana or to raise the tonus of the trapezius, when performers complain of increased tension or a tendency to spasm. The joint line tenderness test also falls into the area of palpation, even if the results become clearer when pressure is applied to the joint space with the fingernail instead of a rather sensitive fingertip. The palpation can also detect thermal changes such as inflammation.

Auscultation

One of the methods of physical examination: auscultation. In relation to asanas, excultation refers on the one hand to breathing and its flow or flow interruptions, throat obstructions or constrictions, On the other hand, cracking or crunching noises can sometimes be heard in joints, which provide information about the condition of the joints, or noises in the scapulothoracic gliding bearing. Joints in particular require closer listening and enquiry: Are the noises associated with an unpleasant sensation? Is there a perceptible difference in the regional muscle tensions before and after? Are the sounds reproducible due to the similar movement? In some cases, there is a palpatory equivalent to what is heard.

Tendons can also make audible rubbing noises, also with palpatory equivalent, which then usually indicates tendovaginitis (tendovaginitis). Regularly, in the case of ongoing subluxations or in the reposition of a subluxations both palpatory phenomena take place, which can be described as jumping, as well as acoustic phenomena that correspond to them. In the case of noises emanating from joints, palpation can often be used to guess whether and which disorder is present and whether medical clarification is required. The acoustic impression is also decisive in determining how smoothly a jump to the feet is achieved.

Apparative phonoarthrography and its relative, vibration arthrography, are discussed further below.

Functional tests

Functional tests are a very extensive and informative chapter. Tests always have a test criterion or a test object that is tested for, which can be pathological or physiological. If the test is successful, the test result is described as positive, even if the test subject finds the result subjectively depressing or negative because it proves a disorder. Tests include those for mobility (flexibility) and strength or strength endurance, and more rarely other components of the classic definition of fitness such as coordination or endurance. However, they can also focus on a number of other physiological or pathological behaviours or conditions, such as tests for blood flow or circulatory disorders or tests for pathological or physiological reflexes. In the movement apparatus, important information can be obtained from the side-by-side comparison as well as in comparison with the results of the antagonists of a muscle when it comes to finding sources of disorders.

The functional tests also include neurological tests, at best for intrinsic reflexes such as the triceps-surae reflex (Achilles tendon reflex) or the patellar tendon reflex (quadriceps reflex).

Another area of testing deals with provocation tests, mostly by stretching or tensing muscles, but also by palpation, i.e. tests for pressor pain.
A pain provocation test using stretching would be the Payr sign. However, this is not the end of the testing; the behaviour of joints and muscle chains in kinetic situations is also tested. A behavioural test would be the anterior or posterior drawer test.

There are two quantifiable quality characteristics of tests: specificity and sensitivity. The specificity of a test refers to the probability that healthy people who do not suffer from the disease being tested for will actually have a negative test result. A low specificity therefore means a high false-positive rate. The sensitivity of a test refers to the probability that diseased persons will be recognised as such by this test. A low sensitivity therefore means a high false negative rate.

In addition to the classic tests that are performed by the examiner on the subject or in which the examiner instructs a behaviour or manoeuvre, there are also signs that can occur and be observed independently in the subject’s everyday life, such as the Duchenne limp or the Gowers manoeuvre. All of this, which the examiner can specifically test and observe, together with what the subject notices on their body, must be brought together in the findings so that a diagnosis or suspected diagnosis can be made. In some cases, it is then desirable or necessary to confirm the suspicion, for example by means of imaging such as X-ray or MRI, which is then often used as evidence if the results are favourable. In addition to all publicly known tests, some of which have been evaluated in studies, asanas are also very suitable for testing strength and flexibility, where they are both diagnosis and therapy at the same time. Asanas reveal a lack of strength, but also work on increasing this strength, and the same applies to flexibility.

Differentialdiagnosis

Differential diagnosis DD can be defined as the set of all diseases that match a given set of information I (the findings). If a patient presents with a single symptom, the DD is usually still quite large. With each additional piece of information from the clinical picture, the medical history, the physical examination and possibly later imaging or laboratory diagnostics, the DD becomes smaller until, ideally, there is a clear disease at the end, which is usually found in the ICD. This is then the diagnosis. If this does not yet appear to be sufficiently proven, there are often further investigative methods.

Consolidation of the diagnosis

Imaging

Imaging is only used in exceptional cases to determine the diagnosis, usually only for confirmation if this is still required. However, there are also cases in which functional tests are not sufficiently informative, so that imaging is necessary. Although meniscus damage is usually conspicuous in the corresponding tests, the exact damage and the need for non-conservative treatment cannot always be deduced from this. An arthrosis can behave differently depending on the stage; in conjunction with the medical history, an arthrosis can therefore often be assumed with a certain degree of probability. An X-ray, which shows the narrowed joint space, will then provide initial information. However, a more precise visualisation of the cartilage structure requires a higher-quality imaging method such as an MRI (magnetic resonance imaging), as X-rays only show the absorption of X-rays by calcium, i.e. the bones. In rather rare cases, a contrast MRI is performed, which can usually differentiate between tissues, especially soft tissues, that appear the same in the MRI, because a contrast agent (radiopharmaceutical) has been administered beforehand, which is distributed differently in the tissues. The prerequisite for an MRI is always the certainty that there is no metal in the body. This would be attracted by the extreme field strength of 1.5 or 3 Tesla (30,000 or 60,000 times the strength of the earth’s magnetic field) with such force that it would be pulled out of the body in a flash and damage it as well as the machine. If there is metal in the body or if this is uncertain, there is another high-quality imaging method, CT (computer tomography). Here, too, it is possible to work with a contrast agent to better visualise specific tissue. Computed tomography is also suitable in time-critical cases. In contrast to the above-mentioned CT and MRI procedures, which produce tomographic images (hence the name tomography), scintigraphy uses a gamma camera that can both visualise bones well statically and also depict progressions over the time axis, for example in the metabolism. If the camera is used in different perspectives, a three-dimensional model can be calculated from the images, which in turn can be used to derive slice images as with CT and MRI. The PET scan (PET-CT, PET-MRI) is based on a different effect than the other radio procedures, namely the interaction of the beta radiation emitted by a radiopharmaceutical with local electrons, whereby high-energy photons are emitted in opposite directions. This method is also well suited for visualising the course of the process.

Incidentally, we can only recommend that you keep copies of all findings yourself, as they may not be available in the long term. Especially in times of increasing digitalisation, MRI images are no longer always handed over on data carriers such as DVDs, but can be accessed online for a limited period of time. Whether this would still be the case after years and one or two changes to the IT of the company that created them is highly doubtful. However, the previous findings are particularly important for monitoring progress and evaluating therapy and personal behaviour over the time that has passed between two imaging sessions.

Laboratory

As far as diseases of the movement system are concerned, laboratory tests of the blood, faeces or cerebrospinal fluid are much less important than in other areas of medicine, such as internal medicine or infectiology. Nevertheless, they can play a role in underlying diseases that also affect the musculoskeletal system. For example, blood parameters from bone metabolism can play a role in suspected damage to the bone substance. In the area of the musculoskeletal system, these would include, among other things: Calcium, vitamin D, AP (alkaline phosphatase), CK, creatinine, uric acid, CRP and rheumatoid factors.

Other and lesser-known examination methods

Infrared thermography

Infrared thermography is a non-invasive, non-contact examination method that can detect faults in many cases, particularly in side-by-side comparisons. A prerequisite for the examination is that the person being examined has not ingested any vasoactive substances, has not done any sport or visited the sauna and has not undergone any physiotherapy treatment immediately beforehand. In 85% of cases, infrared thermography correctly indicated a meniscus lesion. In the case of PFPS, 96% showed a typical overheating pattern, and the measured temperature was one to three degrees above normal. In half of these cases, grade one or two chondropathia patellae was then detectable arthroscopically. Even after osteosynthesis, a temperature increase of up to 2 degrees can be seen, which decreases again one to one and a half months after the fracture has healed. If an implant loosens, a usually permanent temperature increase of up to 2 degrees can be detected, and up to 4 degrees in the case of infections. As thermography has not yet been well researched and documented, there is still a lot of research to be done. Meanwhile, Morbus Sudeck (CRPS 1, algodystrophy) is the only disease with an indication for thermography.

Phonoarthrography

Although auscultation goes back at least to Hippocrates, he related it to the lungs and heart and correctly described, for example, the creaking of leather in pleurisy. It was not until 1883, following the invention of the stethoscope (Laennec, 1816), that Hüter turned his attention to the joint and claimed that he could localise free joint bodies by auscultating the joint with the stethoscope. When Erb connected a microphone to an oscilloscope in 1933 in order to examine sounds more objectively, phonoarthrography was given new impetus. However, he then also suggested vibratory arthrography, which he considered to be more promising.

Damage, especially to the knee joint, is often associated with specific noises. A microphone applied to the patella with simultaneous angle measurement in the knee joint between the thigh and lower leg during squats represents the relationship between the sound and the flexion. This achieves increased precision compared to the classic method with the stethoscope and at the same time correlates noise with angle. If there is joint effusion, there is little or no noise. If the capsule is thickened like a pannus, the noises are noticeably duller. The type of tissue affected by a change and the type of change determine the sound. The distinction between noise and sound, as with hearts, is not applicable here: physiological noises can be: a one-off crack or a reproducible crack in the same situation. A one-off crack when bending the knee joint is considered to have no pathological value; this also applies quite reliably to a repeated, but fading crack. In the case of gonarthrosis, the noise usually extends across the entire range of motion. If there is retropatellar cartilage damage such as chondropathia patellae or retropatellar arthrosis, the noise is usually in the range between 20 and 60° flexion.
Rubbing and crackling are always suspected cases that need to be investigated. The flexion angle in the knee joint can provide clues. Free articular bodies such as ossicles can also cause noise. There is still a need for research in aparative phonoarthrography.

Vibration arthrography

Three different types of signals are also registered in subjects who have been found to be knee-healthy: firstly, crepitation over the
patella, which occurs in 99% of cases, secondly, a patella click and thirdly, a lateral band phenomenon in the area of the outer collateral band, which was seen in 22% of cases in a study series. All other vibration phenomena indicate disorders such as meniscus injuries, plica syndrome, degenerative cartilage changes. There are pronounced results in retropatellar disorders such as chondropathia patella or retropatellar arthrosis, even before radiological changes can be detected. If an meniscus lesion is intervened in arthroscopically, the pathological vibration signal is then reduced to around a tenth of its original strength. Vibration arthrography can therefore be used to provide a measure of the quality of the intervention. Vibratory arthrography is now considered by many to be more promising than phonoarthrography, but there is still a need for further research.

EMG

Electromyography is an electrophysiological method that measures potentials in muscles, either as surface EMG or as deep EMG by means of appropriately placed needles acting as electrodes (approx. 0.45 mm diameter at 5 cm length), which can map muscle activity down to the level of fibre bundles or motor units, while surface EMG records areas into which other muscles can interfere, usually due to their similar location rather synergists. EMG can be used to distinguish neurological deficits or limitations from diseases of the muscle itself. For this purpose, the resting potential and the potentials under different degrees of voluntary tension of the muscle are derived. Surface EMG is also used in biomechanics and sports applications.

Pedobarography

Measurement of the pressure distribution of the foot when standing or walking. Measurements are usually taken on a pressure plate that can be walked on, but insoles with sensors for shoes also exist. The walk-on pressure plates generally have a much higher sensor density. Pedobarography is well suited to detecting foot misalignments or unphysiological postures and load patterns. In the context of corrective surgery, a comparison of the pressure distribution before and after the operation can be used to monitor success. Pedobarography also plays a role in sports biomechanics and in research into gait and running as well as in diabetology. The origins of pedobarography date back to 1882 with the first experiments using rubber and ink.

Therapy

Once the diagnosis has been established, the next step is therapy; therapy without a diagnosis is by definition not possible. Only in rare cases is there no treatment option at all. However, a distinction must be made between restitutio ad integrum, i.e. complete recovery, i.e. the unrestricted restoration of the physiological state on the one hand, which is not possible in all cases, and palliative, delaying or remission-inducing therapy on the other. The patient is then offered one or more treatment options. The choice of suggested options can vary depending on the individual’s different parameters. For example, a young person who still has large parts of their working life ahead of them and has certain sporting ambitions would often be recommended different options than a person who is presumably approaching the last years of their life and already leads a purely domestic life that is restricted in many respects. Furthermore, not all treatment options are causal, i.e. address the cause; there are also symptomatic treatment options. It goes without saying that it is the duty of the practitioner to inform the patient about the type of therapy:

What sensible treatment options are available?
Is it a causal therapy or a symptomatic one?
Are there costs associated with the treatment options that are to be borne directly by the treating party (and not, for example, by their health insurance company)?
Which of the treatment options enables a restitutio ad integrum and with what probability?
What risks are associated with the individual treatment options?
What side effects are possible or to be expected during or shortly after treatment and what is the long-term prognosis?

In all cases in which the patient can consciously decide freely from a medical point of view, it is exclusively his choice which therapy is carried out. With the exception of severe cases of psychopathology, the practitioner may not carry out any therapy against the patient’s will as long as the patient is still able to articulate it. A violation of this rule may constitute an offence of bodily harm. In cases of more serious decisions that are not highly time-critical, it may be worthwhile for the patient to obtain a second professional opinion in order to be more certain about the decision they are inclined to make or to be shown new options. After all, not every practitioner is equally diligent and equally well informed.

The yoga teacher and the state healthcare system

As described above, the yoga teacher is not allowed to diagnose and treat without further qualification.
What are his options if his student describes a symptom to him that could be relevant to the performance of the asanas? And how does he even know whether or that it is relevant?
One option is to ask for medical clarification of any symptoms described and to ask what restrictions this symptom or diagnosis means for the performance of the asanas. It only takes a short period of teaching experience to realise that this path is not feasible.
There are many factors that make it unfeasible:

The pupil lacks the time or motivation for clarification.
The pupil does not receive a prompt appointment for clarification.
The diagnosis is simply not made.
Behaviour in the sense of what to do and what not to do is not recommended to the student.
The practitioner has not the faintest idea of what the student can expect in the area of asanas and is generally not interested in finding out about it.

It can be assumed with a probability bordering on certainty that at least one of the factors torpedoing this method would be present in a specific case, and in practice there are usually several. So sooner or later, the student will be faced with insufficient information and the teacher will once again be faced with the question of what can be done and what should be avoided, only now he knows that there is hardly any chance that the student will be able to obtain this information from outside.

So if this path is not feasible, what would an
alternative, responsible and legally compliant path look like?
It is clear that the burden of responsible judgement will lie with the yoga teacher. Within the framework of the prohibitions, they can only make recommendations, but they can do this conscientiously and professionally
adequately if they undergo the time-consuming process
of continuing professional development. However, this represents a very extensive excursion from his original domain into anatomy, physiology and pathology, which cannot be completed in a short space of time and with little effort. It can hardly be accomplished in less than 100 hours. In addition, he will usually first have to find an institution that can qualify him in this way. This would allow him to assess with a sense of proportion what can be carried out, pending further findings, and possibly with what modifications, and when medical clarification should be sought with a certain degree of urgency. If he then also undertakes to obtain a healing licence, his scope for action is far greater. However, the time and effort required to do this will take years.

Yoga therapy

By definition, yoga therapy is the use of yoga methods to treat diagnosed conditions. Regardless of who has made the diagnosis, it is therefore clear that yoga therapy may only be carried out by legally authorised persons. However, a look at various media shows a completely different picture. For example, „yoga therapy“ itself, as well as further training on this subject, is offered by people who are not authorised to do so. It is probably only a matter of time before the relevant legislation and case law is introduced. Apart from that, yoga does a lot.